Nurses play a central role in preparing patients for discharge. Diabetes affects one-third of all hospitalized patients, with readmission rates 20% higher for patients with diabetes. Low health literacy affects patients' ability to understand education provided during a hospitalization, especially in diabetic patients who are required to perform complex self-care activities. The rehabilitation nurses within the practicum site struggled to provide adequate diabetes education, leading to patients' readmissions and frequent calls to the nursing unit post discharge. The purpose of this project was to educate nurses on an inpatient unit about survival skills and teach-back approaches to improve inpatient diabetes education. Orem's self-care nursing deficit theory guided the project. Nursing literature provided current evidence-based practice guidelines on diabetes education for the staff education program. An expert panel was used to evaluate the effectiveness of the project in improving rehabilitation nurses' knowledge, skills, and ability to administer patient education to diabetic patients using the teach-back method. All 6 expert panel members agreed that the in-service content was relevant to the environment and would improve the nurses' ability to deliver diabetic education on the rehabilitation unit using the teach-back method. Current knowledge of diabetes education practices and strategies to overcome low health literacy can bring positive social change and improve nursing practice by advancing the nurses' ability to provide inpatient diabetes education.

This purpose of this quality improvement project was to develop an educational training curriculum designed for staff nurses to use the teach-back method with patients with low health literacy during discharge instructions. Health literacy is associated with the ability to read, comprehend, and make appropriate healthcare decisions; the teach-back method asks patients to restate or explain health information in their own words, aiding retention and literacy. Effective staff education plays a critical role in the education of patients during discharge teaching: Nurses must help to ensure that patients and their families understand healthcare information and apply this information in their daily lives. The program was planned in an ambulatory care setting and used conceptual frameworks including the Iowa model and the Plan-Do-Study-Act cycle for quality improvement. The program was informed by evidence in the peer-reviewed literature. The curriculum was contextualized by needs of the care setting. The evidence was organized and analyzed using a review matrix to identify common findings among major studies that were applicable to the context. As an aid to operationalization of the program, an implementation plan and an evaluation plan were developed for use by the institution to move the program forward without additional planning. This project may effect positive social change by addressing a health care need that exists throughout the population and is prevalent in those of lower socioeconomic status. Increasing health literacy among patients is likely to promote improved health outcomes among those who are most vulnerable to illness.

Every year, thousands of congestive heart failure (CHF) patients are readmitted to the hospital within 30 days of discharge. There is a gap in practice in the care continuum of patients with CHF within the transition from hospital to home. One of the factors known to increase a patient's risk for readmission is the lack of patient engagement and self-efficacy regarding the treatment plan. The purpose of this project was to implement a transition of care practice guideline that consisted of the use of a risk identification tool, a customized care plan for patients at high risk for readmission, and a discharge checklist crafted specifically for CHF patients who are at risk for readmission. The practice initiative utilized the Iowa model of Evidence Based Practice as a framework and the teach-back method for discharge education. A sample of 193 patients admitted during a 1-month timeframe fit the inclusion criteria and was generated from the electronic health record. Descriptive statistics were used to analyze the data collected during implementation. In fact, of the 106 CHF patients who benefited from the CHF checklist only 2 required readmission within 30 days, a 1.8% 30 day readmission rate. As compared to the 22% readmission rate experienced in 2017, this represented a considerable improvement, albeit preliminary. Efforts to improve the lives of patients and their families will ultimately serve society well, making a significant contribution to positive social change. Providing comprehensive discharge education to patients using the teach-back method to assess the retention of knowledge will help close the gap in the transition of care between hospital and home, ultimately reducing CHF readmissions.

Health literacy (HL) skills are necessary to understand the context of medical information provided to patients in all settings including the emergency room. People with low health literacy (LHL) have difficulty comprehending and implementing basic tasks such as understanding medication administration. The purpose of this quasi-experimental study guided by Orem’s self-care theory was to determine the effect of using the teach-back method for discharge instructions compared to standard written instructions based on parents’ learning style and HL skills assessed during their visit to the emergency room. The Newest Vital Sign (NVS) tool was reworded to assess the parents’ HL. A panel of experts reviewed the tool independently, judged appropriateness and accuracy of the questions, and suggested minor changes. Interrater reliability was assessed in a pilot study with 14 participants, and the strength of the agreement was classified as good (κ = 0.61–0.80) to very good (κ = 0.81–1.00). The NVS was used to determine the literacy levels of 16 participants. The data were analyzed using the Mann-Whitney U test to compare the median scores in comprehension, adherence, and recall. Results revealed no statistically significant increase in comprehension adherence and recall when using the teach-back method (n = 9) compared to the standard written instructions (n = 7). The small sample size was a limitation. Modifying teaching methods for those with LHL to assure complete understanding of important health information will affect positive social change. Further research addressing low health literacy in parents who speak languages other than English is necessary to assure the results are applicable to the general population.

A quality patient experience is one of the highest priorities for hospitals as patients and families are looking to healthcare providers to meet their demands for quality service. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey measures the extent to which providers effectively communicate pertinent information such as communication about medications. On a 20-bed intermediate care unit, the HCAHPS item scores relating to nurse communication and communication about medicine were inconsistent and, on most occasions, were below the comparison benchmark of the 50th percentile when compared to other like hospitals. The purpose of this quality improvement project guided by the patient-centered care model, needs based theory, and adult learning theory, was to test the impact of an educational module for nurses on best practices for teaching patients about medications. Thirty nurses consented to participate in the teach-back sessions. Results of the pre- and posttest, evaluating the nurses' knowledge and attitude about teach-back, were analyzed using the Wilcoxon Signed Ranks test and findings showed an improvement in knowledge scores (z = -2.833, p = .005). However, no statistically significant changes occurred in nurse attitudes toward teach-back. A comparison of descriptive HCAHPS scores on communication about medications and nurse communication showed that scores improved from a low of 58% top box to 74% after the teach-back education. These findings indicated that using teach-back could enhance communication about medications. Effectively communicating pertinent health information using teach-back may have significant consequences for nurse-patient-family engagement contributing to positive social change.

Numerous scholars have examined multiprocessors and techniques to decrease the heart failure readmission rate and to improve heart failure patient self-management. This project examined a new teaching method to create the experts' awareness of possible solutions to improve heart failure education in a small community hospital. The purpose of this project was the assessment of a new iPad heart failure patient pre-discharge education program video HFPDEV). Pender's health care model (PHM) served as a framework for this project. Five local nursing educator experts (master prepared) were asked to view a new iPad HFPDEV. After reviewing the 15-minute iPad HFPDEV, the local experts were asked to evaluate the video by completing a Likert-type survey, which evaluated the content, process, design, time, and functionality of the iPad HFPDEV along with a section for comments and recommendations. Descriptive analysis was used to analyze the survey results. Four of the experts defined the content, process, design, and functionality of the iPad HFPDEV as 'excellent.' One defined the content, process, design, and functionality of the iPad HFPDEV as 'adequate.' All experts expressed recommendations to improve the IPad HFPDEV by doubling the iPad size with an enlargement of print for easy reading and erecting all teaching iPads on mobile stands. A future pilot project will evaluate the relationship of HF readmission rate to the iPad HFPDEV. Social change will occur when the organization provides HF patients with iPad HFPDEV that will increase HF self-management skills and decrease HF readmissions.

Patients with limited health literacy often fail to understand verbal and written discharge instructions, and they frequently return to the emergency department (ED) for care. Patients returning to the ED and 30-day readmission rate are core quality performance measures. The purpose of this project was to decrease repeat visits and readmissions to the ED by implementing components of health literacy programs within the ED on patient education and written discharge instructions. Change implementation consisted of (a) use of teach back method (b) modifying medical terminology to language that patient could understand (c) limiting use of words with more than three syllables and (d) discouraging nursing practice of copying and pasting other completed clinician notes in discharge notes. Following the tenets of the logic model and Watson's caring theory, ED nurses (n=45) at a veteran's healthcare facility participated in the modification of the ED discharge note design. A retrospective quantitative design was used to obtain data from 5,474 records related to each patient's language preference, educational level, and the readability index of the discharge note pre-and post-modification of the note. The comparative analysis of the descriptive statistics before and after modification of the discharge note indicated a decrease of 1.75% in the readability index of the discharge note, a 24% decrease in return visits within 30 days and a 40% decrease in readmission rate within 30 days. Healthcare costs and health disparities associated with health literacy decrease if patients comprehend discharge instructions. Understanding verbal and written discharge instructions correlates with healthy communities. Health literacy policies and technological innovation can promote health literacy and research on health literacy.

The most important aspect of an encounter between a patient and his or her provider is the patient's ability to understand and implement the treatment plan and self-care instructions conferred by the provider. However, the literature in the field of patient-provider communication reveals that there is a noticeable gap in health literacy in certain patient populations that impairs their ability to understand pre-, during, and post-encounter paperwork, terminology, treatment plan, and critical self-care instructions. This has been shown to have detrimental consequences on patient health outcomes. The teach-back method, in which providers request patients to repeat key information discussed during the encounter in their own words, has been shown to successfully improve patient satisfaction, self-efficacy, and knowledge post-encounter. This paper seeks to investigate the impact of health literacy and teach-back on patient satisfaction, self-efficacy, and knowledge, and to determine the effect of a teach-back training intervention on the usage of teach-back during a patient-provider encounter. A total of 88 patients and 11 providers participated in this study over the course of two semesters. A pre- and post-encounter questionnaire was provided to patients and a post-encounter questionnaire to providers. Data regarding teach-back instances during the encounter were obtained via transcripts of encounter audio recordings. Training was given to 17 providers between semesters, 11 of whom were participating in a larger study data collection, and pre- and post-training teach-back instances were compared. The data were coded and statistically analyzed. The results were that there was a statistically significant relationship between health literacy and patient satisfaction as well as patient self-efficacy. Additionally, there was a significant relationship between teach-back and patient self-efficacy with an upward trend observed on the knowledge measures post-teach-back. Teach-back interventional training was also seen to have a statistically significant impact on provider use of teach-back during the patient encounter. Additional research in this field observing fidelity of teach-back practice and observing impacts of teach-back on a separate non-student population could be beneficial in improving patient encounters.

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Heart failure is a complex heart disease that incapacitates more than 5 million people, is associated with increasing healthcare cost, and remains the leading cause of admission in the United States. As the United States faces increasing financial burden related to readmission of heart failure patients within 30 days of discharge, many healthcare institutions are evaluating interventions to determine the most effective opportunities to improve systems, including nursing practice. The purpose of this doctoral project was to improve readmission rates within 30 days of discharge from an acute care facility through the development and implementation of a standardized, evidence-based, patient-centered discharge education toolkit using the Teach-Back method. Orem's self-care theory and the situation-specific theory of heart failure self-care were utilized as a theoretical framework to inform this doctoral project. The sources of evidence were obtained from the Get With The Guidelines-Heart Failure database and through a review of nursing and health-related databases. Descriptive statistics were used to compare the pre- and posteducation session readmission rates. The rate of readmissions occurring within thirty days of discharge pre- and post-educational session retrieved from the GWTG-Heart Failure database were 9.4% and 0.0% respectively. These results showed that this discharge toolkit reduced heart failure 30-days readmission rates. The limitations and strengths of this project will be used to guide further research on heart failure readmission and self-care management. This DNP project will promote positive social change for clinicians, who can use this discharge toolkit to improve self-management in adults with heart failure and thus decrease the costs related to readmission.